Critical Care and Shock

February 2006

Demyelinating disease of the brain presenting as ring enhancing lesions in a critically ill patient

A 26-year-old Latin-American woman with a history of alcohol and cocaine abuse was brought to the emergency department with the complaint of fever, altered mental status and weakness of 3-day duration. Her initial vital signs included a blood pressure of 80/40 torr, heart rate 140/min, respiratory rate 32/min, SaO2 96% on room air, temperature 41oC. Aggressive fluid resuscitation was started, blood cultures obtained, and empiric antibiotics started. A lumbar puncture revealed six white blood cells per field with normal glucose levels.

Read more »

IABP deployment in critical care

The Intra Aortic Balloon Pump (IABP) is an established support in addition to pharmacologic treatment of the failing heart after myocardial infarction, unstable angina, cardiac surgery and percutaneous coronary intervention (PCI). The indication for IABP in acute myocardial infarction expanded to include support of severely ill patient during acute cardiac catheterization and myocardial revascularization both percutaneous and surgical. An international randomized trial, SHould we emergently revascularized Occluded Coronaries for cardiogenic shocK?

Read more »

Delayed neutrophil apoptosis in patients with multiple organ dysfunction syndrome

Aged neutrophils undergo spontaneous apoptosis and delayed apoptosis is associated with persistence of inflammatory disorders through release of toxic metabolites. We evaluated spontaneous apoptosis of neutrophils in patients with multiorgan dysfunction syndrome and neutrophil respiratory burst activity. Neutrophil apoptosis was assessed at study enrollment and after 24 hours incubation in culture medium by annexin-V assay, morphology and DNA fragmentation. Respiratory burst activity was measured using dihydrorhodamine.

Read more »